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Omitting 25 owing to the same Dx? It's time you stopped doing it. Proper modifier 25 use doesn't call for a different diagnosis code. Actually, the presence of different diagnosis codes attached to the evaluation & management and the procedure doesn't necessarily support a separately reportable evaluation & management service. The guidelines changed long time back that you don't need to have a different diagnosis to use modifier 25. However it still seems to be easier to get paid if the diagnoses are different. Where to get more information? As per the CPT manual, the information about modifier 25 clearly indicates that you don't have to have two different diagnoses codes to use the modifier. The manual states, "The evaluation & management service may be prompted by the symptom or condition for which the procedure and/or service was provided." Therefore, different diagnoses are not required for reporting of the evaluation and management services on the same date. How it functions : the proof is in the documentation of the evaluation & management service. The documentation of your dermatologist should clearly establish that the visit's purpose was not to carry out the procedure. If you get denials on modifier 25 claims simply because you use the same diagnosis code for the evaluation & management and the procedure, you should appeal thinking your dermatologist's documentation supports separate services. For more on this and for other specialty-specific articles to assist yourdermatology coding, sign up for a good coding resource like Coding Institute.
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